Haliburton Highlands Health Services’ (HHHS) emergency department consolidation plan was shared with the public via County council May 16 – with Minden representatives expressing little confidence in the proposal going forward.

HHHS CEO Carolyn Plummer and board chair David O’Brien faced councillors and some members of the public in the gallery in council chambers in Minden this past Tuesday.

Plummer said the plan is based on the emergency department protocol initially developed in the fall of 2021 when they were first faced with the prospect of multiple, temporary, short-notice, closures of one or both of the County’s ERs due to staffing shortages. She added the protocol had been refined multiple times since “to ensure it would provide as smooth a closure process as possible.”

Plummer said it was only being presented about two weeks out from the Minden ER closure – June 1 – as they wanted to confer with staff on the best way forward.

CEO: ‘staffing will be assessed regularly’

She walked council through staffing plans, physical space changes at the Haliburton site, parking, equipment and supplies, as well as communication.

As for doctors, she said they will have their current staffing prior to the consolidation at the Haliburton site, including one physician from 8 a.m. to 6 p.m. and one from 6 p.m. until 8 a.m. “With this transition, we’re going to be maintaining that, but also adding one additional physician from 9 a.m. until 9 p.m. to deal with the highest volume portion of the day for patients,” Plummer said.

She added they currently have two registered nurses from 7 a.m. to 7 p.m.; and two from 7 p.m. to 7 a.m. One registered practical nurse is on 9 a.m. to 9 p.m. She noted the plan calls for an additional RN from 11 a.m. to 11 p.m. in summer, an additional RN 7 a.m. to 7 p.m., and one from 7 p.m. to 7 a.m., with access to an additional RPN 11 p.m. to 7 a.m. to be shared with the acute care unit. Plummer said there would be an additional nurse in summer and a charge nurse for the day during the transition period.

“Staffing will be assessed regularly and adjusted as needed,” Plummer said.

Minden mayor Bob Carter, during question time, said prior to consolidation there was one doctor in Minden and one in Haliburton at all times, but the new plan calls for 1.5 doctors, “so we are reducing the total emergency doctors…and you feel that is sufficient?”

Plummer answered it was something they had talked about with their physician group. “The coverage we have to operate two emergency departments, and to make sure there’s availability of physicians 24/7, requires two physicians. In a single emergency department, with the combined volume, depending on the time of day, doesn’t always need two physicians. We have added the second physician during the busiest volume time of the day. Our physicians have agreed that in the overnight period, a single physician coverage model is sufficient to manage any additional volume we might experience overnight with this transition.”

Carter pressed Plummer on her comments that the consolidated site was “fully staffed” with doctors.

Going into June, he asked if all 90 shifts were filled. She replied they were still “populating” the schedule. “We have confirmation that we can support that schedule. I’m very pleased actually with the uptake of shifts that have been picked up so far, but right now we are in the same place as we normally would be with filling the Haliburton emergency schedule.”

Carter queried shift coverage for July and August. Plummer said, “we received confirmation last week to go ahead with the schedule as planned and so we will be posting those schedules.”

Carter pointed out that meant no positions were filled as of now. Plummer said they were in the same position they would normally be for the Haliburton site at this period of time. He asked if they had a plan in case the Haliburton site has to be closed this summer, and she said they did.

Plummer said they were working closely with the Ontario Health emergency department locum program and “we’re confident we will have those shifts filled between our own physicians and the emergency department locum program, as we have for the last several years.”

Speaking to other staffing plans, Plummer said diagnostic imaging at the Haliburton site will remain as is, from 8 a.m. to 8 p.m. with on-call coverage after hours. She added there will be increased hours at the Haliburton site for patient registration, lab services, and security. Minden will still do X-rays and bone density testing by appointment. There will be no job losses.

Non-staffing plans

Plummer said emergency department spaces are increasing from nine to 14 or 15. She said a new trauma bed would be added to the existing two. There will be a new procedure/ treatment room with one stretcher, two to three chairs and the ability to interchange one to chairs with a stretcher if needed.

There’ll be a new fast-track/rapid assessment room with exam table and physician work space. Waiting room space is increasing from 14 to 27. Lab space is also being expanded.

Coun. Jennifer Dailloux asked about wait times and Plummer said, “we do anticipate we may see a slight increase in patient wait times.” However, she said it’s hoped the fasttrack and having a second doctor at critical times will keep that increase to a minimum.

The plan is for 15 additional parking spaces.

Coun. Walt McKechnie said he felt for the Minden community but asked how they would feel if both EDs were being closed. He said they had to give credit to HHHS for a decision they did not want to, but had to, make. “I know people are not going to be happy with what I’m saying here, but I’m just trying to be realistic.”